title: Effectiveness of mealtime interventions on nutritional outcomes for the elderly living in residential care: a systematic review and meta-analysis.
abstract: The need to improve the nutrition of the elderly living in long term care has long been recognised, but how this can best be achieved, and whether (and which) intervention is successful in reducing morbidity is less well understood. The aim of this systematic review was to determine the effectiveness of mealtime interventions for the elderly living in residential care. Mealtime interventions were considered as those that aimed to change/improve the mealtime routine, practice, experience or environment. Following comprehensive searches, review and appraisal, 37 articles were included. Inadequate reporting in over half of the articles limited data quality appraisal. Mealtime interventions were categorised into five types: changes to food service, food improvement, dining environment alteration, staff training and feeding assistance. Meta-analysis found inconsistent evidence of effects on body weight of changes to food service (0.5 kg; 95% CI: -1.1 to 2.2; p=0.51), food improvement interventions (0.4 kg; 95% CI: -0.8 to 1.7; p=0.50) or alterations to dining environment (1.5 kg; 95% CI: -0.7 to 2.8; p=0.23). Findings from observational studies within these intervention types were mixed, but generally positive. Observational studies also found positive effects on food/caloric intake across all intervention types, though meta-analyses of randomised studies showed little evidence of any effects on food/caloric intake in food improvement studies (-5 kcal; 95% CI: -36 to 26; p=0.74). There was some evidence of an effect on daily energy intakes within dining environment studies (181 kcal/day, 95% CI: -5 to 367, p=0.06). The need to improve the nutrition of the elderly living in residential long term care is well recognised. This review found some evidence that simple intervention around various aspects of mealtime practices and the mealtime environment can result in favourable nutritional outcomes. Further large scale pragmatic trials, however, are still required to establish full efficacy of such interventions.
authors.affiliation: PenCLAHRC, University of Exeter Medical School, Veysey Building, Exeter EX2 4SG, United Kingdom. Electronic address: R.A.Abbott@exeter.ac.uk.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Abbott
authors.forename: Rebecca
authors.initials: R
authors.lastname: Whear
authors.forename: Jo
authors.initials: J
authors.lastname: Thompson-Coon
authors.forename: Obioha C
authors.initials: OC
authors.lastname: Ukoumunne
authors.forename: Morwenna
authors.initials: M
authors.lastname: Rogers
authors.forename: Alison
authors.initials: A
authors.lastname: Bethel
authors.forename: Anthony
authors.initials: A
authors.lastname: Hemsley
authors.forename: Ken
authors.initials: K
authors.lastname: Stein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight / Q000502:physiology; D061345:Early Medical Intervention / Q000379:methods*; D004435:Eating / Q000502:physiology / Q000523:psychology*; D002149:Energy Intake / Q000502:physiology; D006707:Homes for the Aged; D006801:Humans; D062407:Meals / Q000502:physiology / Q000523:psychology*; D024802:Nurse's Role; D009752:Nutritional Status / Q000502:physiology*; D012112:Residential Facilities / Q000379:methods; D016896:Treatment Outcome
keywords: Dementia; Dining; Elderly; Food; Nutrition; Residential care